We aimed to evaluate the feasibility of left ventricular electroanatomical mapping to choose between left bundle branch area pacing (LBBAP) or coronary venous pacing (CVP).

There are several ways to achieve left ventricular activation in cardiac resynchronization therapy (CRT): LBBAP and CVP are two possible methods of delivering CRT. However, the criteria for choosing the best approach remains unknown.

A total of 71 patients with heart failure, reduced ejection fraction, and left bundle branch block (LBBB) were recruited, of which 38 patients underwent the three-dimensional electroanatomical mapping of the left ventricle to accurately assess whether the left bundle branch was blocked and the block level, while the remaining 33 patients were not mapped. Patients with true LBBB achieved CRT by LBBAP, while patients with pseudo-LBBB achieved CRT by CVP. After a mean follow-up of 6 months and 1 year, the QRS duration and transthoracic echocardiography, including mechanical synchrony indices, were evaluated.

Twenty-five patients with true LBBB received LBBAP, while 13 without true LBBB received CVP. Seventeen patients received LBBAP, and 16 patients received CVP without mapping. Paced QRS duration after the implantation of LBBAP and CVP was significantly narrower in the mapping subgroup compared to the non-mapping subgroup. A significant increase in post-implantation left ventricular ejection fraction was observed in patients with LBBAP or CVP, and the mapping subgroup were better than the non-mapping subgroup. After a 12-month follow-up, atrioventricular, intraventricular, and biventricular synchronization were significantly improved in the mapping subgroup compared to non-mapping groups in both LBBAP and CVP.

In our study, three-dimensional electroanatomical mapping was used to choose LBBAP or CVP for heart failure patients, which proved feasible, with better cardiac resynchronization in the long-term follow-up. Therefore, three-dimensional electroanatomical mapping before CRT appears to be a reliable method for heart failure patients with LBBB who are indicated for CRT.

我们旨在评估左心室电解剖标测在左束支区域起搏 (LBBAP) 或冠状静脉起搏 (CVP) 之间进行选择的可行性。

在心脏再同步化治疗 (CRT) 中有几种方法可以实现左心室激活：LBBAP 和 CVP 是提供 CRT 的两种可能方法。然而，选择最佳方法的标准仍然未知。

共招募了 71 例心力衰竭、射血分数降低和左束支传导阻滞（LBBB）患者，其中 38 例患者接受了左心室三维电解剖标测，以准确评估左束支是否受阻以及块级别，而其余 33 名患者未映射。真性 LBBB 患者通过 LBBAP 获得 CRT，而假性 LBBB 患者通过 CVP 获得 CRT。平均随访 6 个月和 1 年后，评估 QRS 持续时间和经胸超声心动图，包括机械同步指数。

25 名真正的 LBBB 患者接受了 LBBAP，而 13 名没有真正的 LBBB 的患者接受了 CVP。17 名患者接受 LBBAP，16 名患者接受 CVP，但未进行标测。与非映射亚组相比，映射亚组中植入 LBBAP 和 CVP 后的起搏 QRS 持续时间明显更窄。在 LBBAP 或 CVP 患者中观察到植入后左心室射血分数显着增加，并且标测亚组优于非标测亚组。经过 12 个月的随访，在 LBBAP 和 CVP 方面，与非映射组相比，映射亚组的房室、心室内和双心室同步显着改善。

在我们的研究中，使用三维电解剖标测为心力衰竭患者选择LBBAP或CVP，证明是可行的，在长期随访中心脏再同步性更好。因此，CRT 前的三维电解剖标测似乎是适合 CRT 的 LBBB 心力衰竭患者的可靠方法。